Lecture 3 Medicine

Lecture # 3 Oral medicine

‫بسم الله الرحمن الرحيم‬ Bacterial infections

Today we are going to talk about bacterial infection , the details u will find them in the text book ,and in the essentials of oral medicine ch. 13 Any of these micro organisms can cause a disease only if they manage to get access and grow in the body , we can have them normally in the body and not causing any disease but to be a pathogenic they have to break the immunity shielder like the tears of the eye , the oral mucosa and the skin and they need to over come the presence of the normal flora which is part of the oral cavity , any decrease in the oral flora will allow the space for these pathogenic bacteria to grow and increase in number , they have to over come the inflammatory response , the macrophages the neutrophils that are present in the connective tissue in the oral epithelium and finally they have to over come the immune response the specific t-cells and b – cells producing the specific antibodies .. If they manage to over come all these lines of defense then this pathogen can cause a disease .. Pathogens can be transformed via air , dust , particles , water droplets , hands or objects or blood and other body fluids .. and if u are aware of the term opportunistic pathogens they 1| Page

Lecture # 3 Oral medicine are part of the normal flora that increase in number in reduction of immunity and they cause a disease .. Bacterial endocarditis :

One of the topics I thought we need to talk about is the bacterial endocarditis and we are going to talk about them briefly , the mouth in general is a host for many pathogens .. and the presence of an ulcer or trauma or even the tooth it self can be the access of these pathogens to the blood stream and then causing the bacterial endocarditis .. We have high risk patients and moderate risk patients .. the Dr mentioned only some of the high risk which they are : prosthetic heart valves , recurrent attack of bacterial endocarditis (the rest are in the slides ) but any patient can be infected , any healthy patient can be infected because of any dental infections .. so these patients we give them prophylactic antibiotics before we do any dental procedure we suspect that it might cause a bacteremia (the procedure that deals with blood like extraction , root planning , periodontal treatment ) other procedures like impression or filling it doesn’t require a prophylaxis antibiotics .. here a student was discussing with the Dr the antibiotic prophylaxis and the indication saying that its not indicated any more as we took in the surgery or perio and the Dr said its controversial and its up to the dentist who is on the case .. You need to select the appropriate antimicrobial drug and there is a certain routine for the antibiotic you give , then u need to illuminate all sources of periapial and periodontal lesions .

2| Page

Lecture # 3 Oral medicine Now we will start talking about some of the bacterial infections that we will see in the oral cavity … Impetigo : Is an infection in the skin , its not affecting the oral mucosa but its very common affecting the paraoral regions it affects mainly young children coz they are very susceptible for skin trauma which is a very good environment for the bacterial accumulation and infection , it will start as a vesicle then pustules and then it will cause this amber -colored crust , so usually boys at 6- 7 yrs old have these skin lesions , the treatment is a course of antibiotics fucidine its very good to treat these infections and you should insist on the hygiene habits and the hands and face cleaning . Tonsillitis and pharyngitis : They are part of the oral cavity , we need to differentiate between viral and bacterial infections of the tonsils , you can see yellow spots they are called follicles this type of tonsillitis is called follicular tonsillitis , its associated with very high temperature , enlargement of the uvula (edematous) and coated tongue , these features are more associated or found in the bacterial tonsillitis or pharyngitis , you have to recognize these features so if a patient comes to you with follicular tonsils u have to refer him to GP (general practitioner ) to give him a course of antibiotics , other wise it might progress and cause scarlet fever (‫)الحمى القرمزية‬or rheumatic heart disease .. Tuberculosis : They thought that TB infection has vanished and is not in the world any more but with the accurance of HIV patients and

3| Page

Lecture # 3 Oral medicine there low immunity it did come back and it affects many people … Tb starts as a an acute infection presented with fever chills, fatigue & malaise weight loss , lymphadenopathy , Enlarged submandibular & cervical LN after these acute symptoms we have the chronic phase here there is no respiratory symptoms yet but the patient can still spread the infection, so when u take the medical history u ask the pt if he has fever or noticed weight lose and u examined him and u find his cervical lymph node are palpable u have to suspect TB … orally it can be present as painful non-healing ulcer usually on the dorsum of the tongue & the palate and its caused by the sputum from the infected lungs and the bacteria in the mouth will react with the sputum and cause these ulcers, to diagnose the disease we need to have a biopsy from the ulcer , so any long standing ulcer u need to suspect TB and take a biopsy , so the biopsy is part of your diagnosis .. another diagnostic method is the Purified Protein Derivative (PPD) where u inject the TB antigen in the patient subcutaneous tissue and see him after 24 or 48 hrs if u notice any allergic reaction it means that the patient was infected by these antigen before and he has the antibodies in his serum or blood so this confirms that the patient is infected with TB if there is no allergic reaction then the pt probably is not infected with TB , the universal precautions for a TB patient they are the mask, gloves, eye protection are enough if u are dealing with TB patient , no elective treatment should be given to an active TB patient , u need to assist the condition of the pt and in which stage he is , and u need to know these information from his Dr not the patient him self .. the treatment of TB was not mentioned by the Dr but we all know that it is a long course of antibiotics 6-12 months … 4| Page

Lecture # 3 Oral medicine Syphilis : Is caused by spirochete (Treponema pallidum). It’s a sexually transmitted disease it can be transmitted by blood or from the mother to the fetus through the placenta causing the congenital syphilis .. it has three stages .. the first one is chancre (primary) it appears as ulcer very red ulcer it can present at any part of the mouth , tongue or the lip , it lasts for few weeks then it disappears for a couple of weeks then it comes back as a secondary syphilis which is presented as mucous patches on the lip or the tongue or any part of the oral mucosa , cutaneously u might have the maculae in the hands or the feet this lesion is very contagious , always conduct a serological test for an unknown origin ulcer , then we will have the tertiary stage which again can appear in different forms like the Gumma here it started as an ulcer then necrosis of the bone in the palate and causing perforation it might affect the nasal septum causing a saddle nose (not sure) , other lesions like syphilitic leukoplakia which are white lesions that are not frictional lesions or due to smoking and the only way to diagnose it is to take a biopsy , or it can appear as a fibrosing glossitis or syphilitic glossitis all these are confirmed by a biopsy , the syphilitic leukoplakia and fibrosing glossitis are premalignant lesions so when doing the biopsy the pathologist will notice the amount of dysplasia in these two .. the bacteria might spread to the CNS the patient might develop some behavioral changes and these problems might be thought to be aging behavioral while its not and when the patient is given the antibiotics his mental abilities will improve .. Congenital syphilis : Here the child is born with the syphilis because of his infected mother and they have Hutchinson Triad : deafness , 5| Page

Lecture # 3 Oral medicine blindness and dental anomalies such as Hutchinson incisors and mulberry molars . Diagnosis .. many serological tests are performed to diagnose it , and treatment is usually penicillin for very long time … Gonorrhea : is another sexually transmitted disease the oral presentation is very rare , ulcer and Oral Erythema , tonsillitis and other infections in general can be caused by gonorrhea . and u can diagnose the disease by Gram stained smear you can diagnose the disease . non _specific urethritis : the bacteria Chlamydia species can induce urethritis and the Reiter’s syndrome (reactive arthritis) the clinical picture is similar to urethritis but this (Reiter's ) is with arthralgia (pain in the feet )and swelling of the joint (accumulation of the fluids in the joints) other features are involved like the eye . Circinate stomatitis is one of the presentation of Chlamydia species are very similar to the geographic tongue with a region of depapillated area and whitish margins of the tongue the diagnosis is by the bacterial gram stain smear and the treatment is by antibiotics

Acute Ulcerative Necrotizing Gingivitis

(AUNG) :

We toke it in oral pathology and its one of the bacteria affecting the oral mucosa mainly affecting the gingival and the periodontal ligament the treatment is metranidazole coz we are dealing with non aerobics bacteria fusiform bacillus & 6| Page

Lecture # 3 Oral medicine spirochete (Borrelia vincentii). As u see here the interdental papilla is damaged by this disease and we need to improve the oral hygiene and before that we need to scale the tooth and remove all depridment then to enforce the oral hygiene habits ..

Osteomyelitis : We are trying to cover all the bacterial infections and caries is one of them , chronic and aggressive periodontitis are caused by bacteria as well but we didn’t talk about them but the point is that the oral mucosa and the teeth are not the only structures that can be affected we have also the bone that can be infected by bacterial inflammation . The main source of bacteria is either through periapical infection (the main source) , or after operation or surgery where contamination took place or fracture of the jaw that led to communication between the oral cavity and the bone deep tissue .. The patient comes with acute symptoms very sever throbbing pain combined with a swelling intraoral or extra oral , some times when it stays for a long time there will be sinus track showing intra or extra oral sinus , after these acute symptoms there will be lymphadenopathy and fever and the patient is not feeling well , to diagnose the disease you need a radiograph , in the radiograph in the slides we see a radiolucent area on the periapical region of the 6 (we call it mouse eaten appearance)and there is sclerotic and fibrosis tissue and with time it will have this appearance which is the highly dense bone or condensed bone cause of the inflammation here the treatment will be removing the source

7| Page

Lecture # 3 Oral medicine of infection and bone curettage and removing all the necrotic bone of course with antibiotics ..

ThE EnD The lecture didn’t include every thing in the slides so u have to refer to them while reading the lecture .

،‫و شاهق‬ ُ ‫هل كان علينا أن نسقط من‬ ّ ُ ‫عل‬ ‫درك أننا لسنا‬ ْ ُ ‫ لن‬...‫ونرى دمنا على أيدينا‬ ‫ كما كنا نظن؟‬..‫ملئكة‬ At the end I wanna say sorry for being late but it was out of my hands And I just wanna say hi to every one in our dof3a starting by my friends : maram , noor , do3a2 , ithar , zain , arwa , deema , '3ada , jomana m7esen , jomana ta3amneh , amal el 3omare , fatema as3ad , tina , dana … Sorry if I forgot anyone

Done by : Abeer S. Al Najjar

8| Page